Letters|1 March 1993

Full-Time Clinicians as Teachers

A recent issue of Annals contained two articles [1, 2] that raise serious questions about the ability of academic faculty to do adequate examinations and to supervise housestaff. I attended for 15 years at the County Hospital in Los Angeles and share that opinion.

My colleagues and I do not miss 40% to 60% of cardiac diagnoses when valvular heart conditions are present. In the trenches, we ferret out the signs and symptoms that require further evaluation and stop workups when appropriate. We call this “the practice of medicine.”

The appalling record among the housestaff at Duke University [1] suggests that well-trained practitioners should once again be encouraged to attend and to teach the students, interns, and residents. As we go further into managed health care, the efficiency and accuracy of diagnosis based on the assessment of clinical signs, symptoms, and the appropriate physical findings will be essential. One can hardly expect someone spending 80% or 90% of their time in research and administration to maintain skill and currency in this area.